Game Reveals Why People Skip Condoms, Vaccinations

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A new game, loosely modeled after the spread of gonorrhea, offers
a new way for researchers to study people's motivations for
choosing whether or not to use condoms, get flu shots or
otherwise protect themselves from epidemics.

The game may be the first specifically designed for studying the
spread of diseases, its developers wrote
in a paper published Jan. 9 in the journal PLOS ONE.
With the game, researchers can ethically study people's behaviors
during epidemics. In real life, of course, performing certain
experiments, such as releasing a disease or making vaccines more
expensive for some people than others, would be deplorable and
highly unethical.

"With this virtual world approach, we can do all kinds of policy
experiments," said Frederick Chen, an economist at Wake Forest
University in North Carolina and the lead researcher in the
development of the gonorrhea game.

This isn't the first time researchers have tried using game
versions of diseases as a proxy for real life. In 2007, some
epidemiologists published studies of
how "Corrupted Blood," a disease in the massive online game
" World
of Warcraft," mimicked real-life outbreaks. What's new about
Chen's game is that it's a simple game built for doing controlled
experiments.

"We wanted to strip the problem down into the most essential
components and to analyze incentives," Chen said. "If we think
about a multiplayer, online game like 'World of Warcraft,' you
have a lot of other things going on."

In the future, games like Chen's could complement surveys that
researchers already conduct, which ask what people thought and
did during real disease outbreaks, Chen thinks. Together,
insights from surveys and games could go toward the design of
ads, laws and other campaigns for preventing flu
epidemics like the one gripping the United States now.

Chen and his colleagues, including other economists and one
computer scientist, recruited 102 people to play their game over
45 days. Every day, the study participants got emails saying
whether or not they were sick and what their likelihood was of
getting sick the next day. Healthy players could choose either to
buy protection for the day or take their chances unprotected.
"Sick" players could do nothing for a day. [SEE
ALSO: Man
Infects Himself with Computer Virus ]

That simple disease model is reminiscent of chlamydia or
gonorrhea, Chen and his colleagues wrote, because getting one of
these illnesses doesn't give people immunity later, the way
getting the flu does. The game-disease also doesn't kill people
off. The team chose this model so that players could keep getting
infected, and keep playing, giving the researchers plenty of
data.

Participants earned more points by staying healthy, with the most
points going to those who stayed healthy without protection
because they didn't have to spend their virtual money. At the end
of 45 days, each player's points translated into money on an
Amazon gift card. The top players earned about $25, Chen said.

Game lessons

The game offered some insights not available from current
mathematical models, another way to virtually and ethically study
disease spread, Chen and his colleagues found.

The study of how people act during epidemics is a young field,
however, so researchers tend to use simple models, Chen told
TechNewsDaily. Such models assume, for example, that people
always act rationally if they know all the rules of the game.
[SEE ALSO: 9
Super-Cool Uses for Supercomputers ]

In Chen's game, however, that assumption didn't hold true. People
who happened to get sick early in the game were more likely to
buy protection later in the game, even though they knew they were
just as likely as the non-diseased players to get sick on any
given day.

Chen and his colleagues also found that people acted differently
over time, depending on the prevalence of the game-disease. High
prevalence led to more and more people buying protection as days
passed, while low prevalence led to fewer and fewer people buying
protection as time went on. The latter scenario reminded the
researchers of the reductions in condom use that came with the
fall of HIV/AIDS rates after the 1990s.

That means that letting people know their day-to-day risk of
getting diseases such as the flu could encourage people to get
vaccinated — up to a point. "It's actually difficult to eradicate
disease" because of the way people act once they know disease
risk is low, Chen said.

Experiments for the future

Chen's results often echoed what other researchers already knew
from surveying people after real-life epidemics. That shows a
game can be a realistic way to study what would happen in
reality, Chen said. At the same time, games can go beyond surveys
since they don't have to rely on people's poor memories and can
avoid cases in which respondents don't follow through with their
stated intentions, he said.

Next, Chen hopes to get funding to study more disease scenarios
with games. For example, his team could test different illnesses,
such as a flu-like scenario, in which people become immune after
one infection, or an HIV/AIDS-like scenario, in which people
don't know right away that they're infected.